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We read with great interest the paper of Choe and colleagues who
investigated possible relationships between H. pylori infection with iron
deficiency anaemia (IDA) and subnormal growth at puberty. They
concluded that H. pylori infection and related IDA, rather than bacterial
infection per se, might cause delayed pubertal growth. We believe that
Choe et al’s results need some considerations.
H. pylori infection may cause IDA in different ways
(a) the bacterium
causes a decrease in the gastric juice of the concentration of ascorbic
acid, that is the best promoter of non-heme iron absorption
(b) H. pylori may increase iron demand because iron is an essential bacterial
(c) H. pylori contains a 19.6 kDA protein resembling ferritin
with a binding activity for heme iron in erythrocytes
(d) acute or
chronic blood loss and IDA are obviously related to typical H. pylori-
related gastroduodenal lesions.
In Choe et al’s study the treatment of
H. pylori infection with antibiotics (but also with proton pump inhibitors (PPI)) was probably
associated with a more rapid response to oral iron replacement also for
the effects of PPI in healing some of these lesions.
However, IDA, failure to thrive and delayed pubertal growth are important
features of subclinical and silent coeliac disease. Therefore, coeliac
disease should be suspected everywhere in children or adolescents with
these signs, especially when IDA is refractory to oral iron replacement.
In a recent study, both in children and in adults IDA appeared to be
the most frequent extra-intestinal marker of coeliac disease, followed by
short stature for children. Thus, it appears mandatory to screen
paediatric and juvenile populations with IDA and/or failure to thrive
and/or delayed pubertal growth by means of determination of coeliac
related antibodies (anti-endomysial, anti-transglutaminase, anti-gliadin)
in order to identify coeliac patients who need life-long gluten withdrawal
for recover of iron metabolism and growth.
Finally, it is reasonable that H. pylori infection may concur and worsen
iron deficiency in coeliac patients and subsequently impair the growth in
paediatric ages who need a great amount of this essential element.
Lucio Cuoco, MDGiovanni Cammarota, MDRegina Anna Jorizzo, MDRossella Cianci, MDGiovanni Gasbarrini, MD
Corresponding author:Dr L CuocoUniversità Cattolica del Sacro
Cuore, Policlinico “A.Gemelli”Istituto di Medicina Interna e Geriatria Largo A.Gemelli, 8 - 00168Roma, Italia
Fax: +39 06 35502775
(1) Choe YH, Kim SK, Hong YC. Helicobacter pylori infection with iron
deficiency anaemia and subnormal growth at puberty. Arch Dis Child
(2) Banerjee S, Hawksby C, Miller S, Dahill S, Beattie AD, McColl KE.
Effect of Helicobacter pylori and its eradication on gastric juice
ascorbic acid. Gut 1994;35:317-22.
(3) Doig P, Austin JW, Trust TJ. The Helicobacter pylori 19.6-
kilodalton protein is an iron-containing protein resembling ferritin. J
(4) Bottaro G, Cataldo F, Rotolo N, Spina M, Corazza GR. The clinical
pattern of subclinical/silent coeliac disease: an analysis on 1026
consecutive cases. Dig Dis Sci 1999;94:691-6.